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'I’m helping establish an HIV clinic in Timor-Leste’

An Australian volunteer HIV clinician is working with her Timorese colleagues to treat HIV patients, and prevent the spread of infection.

Along with her six colleagues at partner organisation Maluk Timor, Eleanor MacMorran is helping to set up and run an HIV clinic in Timor-Leste. Eleanor describes some of the challenges – low stocks of vital drugs and flooding in the clinic – and rewards of her volunteer assignment so far.

Setting up an HIV clinic in Timor-Leste

Sitting on the floor of Office World surrounded by stationery, I am overcome with doubt.

My colleague Dircia, our clinic team leader, and I have been here for the last half hour, and I’m now certain that the wrong choice of file divider will mean the ruination of our HIV program before it even begins.

Nina and Madalena packaging up patient medications. Our blue plastic pill cutter from Australia is precious, since we often need to cut adult dose tablets down to paediatric size. Supplied: Eleanor MacMorran

Setting up a clinic from scratch is not something I’ve ever done before, and I’m far from confident I have what it takes. Medical school back home didn’t teach most of what I need to know here.

We’ve been meeting with HIV patients for weeks, and having no clinic in which to see them has been problematic. These patient encounters have brought home to me how badly an HIV service is needed.

So, we are moving fast. The clinic has been renovated, plumbed, painted, planted, and equipped with everything we can think of - from curtains to capillary tubes (fine glass tubes we use to collect blood).

This is brand new for all of us, and inevitably we make mistakes.

Somehow, we affixed our wall-mounted height measurer in such a way that it adds an extra 18 centimetres onto everyone’s height.

Establishing the clinic building was an achievement, but I am more excited about establishing our team as a quality HIV service.

My Timorese colleagues are overflowing with enthusiasm, and they absorb information as fast as I can produce it. As well as our Friday ‘HIV class’, in which I deliver as much information as I can, my co-workers are learning a lot by seeing patients, making information leaflets and posters and chatting while we fill countless zip-lock bags with medications.

This knowledge is not just staying within the walls of our clinic, either.

Dircia joined a live TV panel discussing the HIV situation in Timor-Leste, cool as a seasoned BBC presenter.

Dircia (second from the right) participating in a live TV chat show sharing information about HIV to the wider population in Timor Leste. By sharing accurate information Maluk Timor helps reduce stigma and encourage more people to get tested for HIV. Supplied: Eleanor MacMorran

Ano, our counsellor and phlebotomist has no trouble keeping roomfuls of university students riveted as he talks about HIV transmission and risk factors.

Contemplating the rapidly rising incidence of HIV in Timor-Leste turns me cold with fear, since it feels like I can’t possibly do enough to stem the tide.

Perhaps it is this anxiety which translates into the occasional small melt-down on the floor of stationery shops.

It’s true: I can’t possibly do enough to meet the need I see here. But the Timorese people can. And my amazing team are leading the charge.

I just have to try to keep up.

Mud and medicine

Our HIV clinic was flooded last week. One learns to expect rain in the rainy season, but the downpour on the weekend saw much of Dili under water.

By the time I had sloshed my way into work on Monday, my ultra-efficient team had dispatched most of the mud. We were open for business again by 10 o’clock.

The flood was not without casualties, though.

Our expensive, impossible-to-find in Timor-Leste filter paper met a sad fate. This special absorbent paper allows us to send blood samples to Australia using a technique called a dried blood spot.

Visitors passing through our office are generally conscripted to act as carrier pigeons, transporting these bits of paper to the HIV reference laboratory at Saint Vincent’s Hospital in Sydney.

Eleanor (second from left) and the team at Maluk Timor. Supplied: Eleanor MacMorran

HIV treatment decisions can be complicated at times, and our ability to access specialised drug resistance testing for our patients is a big advantage.

One day we hope this kind of testing will be available in Timor; meanwhile we are grateful to our Saint Vincent’s colleagues for their help.

The other flooding casualty was our drowned garden, mired inches deep in mud.

We rely greatly on these few square feet of plant-filled courtyard. If we have a fraught patient, perhaps with a new diagnosis of HIV, we take them to the garden (I take myself there sometimes, during my own fraught moments).

The garden also protects my team from tuberculosis (TB). Sitting safely in the open air, we can spend as long as we like talking with coughing TB patients, without worrying about picking up the infection.

The pre-flood garden at Maluk Timor. Supplied: Eleanor MacMorran

Since the garden is now a swamp, we’ve had to see these coughing patients inside the clinic, and the masks that provide us with protection from TB have been stocked out for weeks.

Stock-outs feature heavily in our lives. For a while we existed uneasily as an HIV clinic without any HIV medicine. And although handing out drugs is not our team’s sole function, these life-saving tablets are certainly at the core of what we do.

This morning, Dr Alfredo talked with a colleague in the pharmacy (attached to our clinic), explaining that it was quite difficult to give good patient care when he had no paracetamol, or penicillin, or fluconazole (an antifungal drug). Then I came back from lunch to find something unprecedented. Sitting on the table was a big brown box, brim-full of everything we had asked for. Even the masks were there!

Maluk Timor is an Australian Aid Friendship Grants recipient, awarded November 2019. Applications for the second round of Friendship Grants close 10 September 2019.

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